Provider Demographics
NPI:1942996012
Name:DANTAM DENTAL PLLC
Entity Type:Organization
Organization Name:DANTAM DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SOWJANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASIREDDYGARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-869-1428
Mailing Address - Street 1:10914 MANUEL ST
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-1435
Mailing Address - Country:US
Mailing Address - Phone:703-869-1428
Mailing Address - Fax:
Practice Address - Street 1:15801 ROLATER RD
Practice Address - Street 2:SUITE 202
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035
Practice Address - Country:US
Practice Address - Phone:469-353-6886
Practice Address - Fax:469-353-6883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty